Does Lower Extremity Ultrasound Have a Role in Ruling Out PE?

The role of venous duplex ultrasound (US) of the legs in patients with suspected pulmonary embolism (PE) is not clear with the advent of d-dimer testing and computed tomography (CT) pulmonary angiography. European researchers prospectively randomized 1819 consecutive outpatients with suspected PE to one of two diagnostic strategies: d-dimer measurement plus chest CT (if d-dimer level is >500 ng/mL; DD-CT) or d-dimer measurement plus bilateral lower extremity venous compression US (if d-dimer level is >500 ng/mL), followed by chest CT if US results are negative (DD-US-CT). Nine percent of patients in the DD-US-CT group did not undergo CT because deep venous thrombosis (DVT) was detected on US, and treatment was started without further testin…